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What factors are prompting payers to look for provider network management solutions?


Patient Protection and Affordable Care Act (PPACA) is a healthcare mandate that payers need to comply with, including its Administrative Loss Ratio and Medical Loss Ratio criteria. Payers have to find ways to improve their organizational efficiency, reduce operation costs, improve benefits coverage, and improve customer satisfaction benchmarks.
PPACA will cover all citizens in the United States eventually. PPACA criteria such as Medical Loss Ratio require insurance payers to allot 80 and 85 percent expenditure on individuals, small group markets, and large group markets to improve healthcare and medical care quality. The rest can be allotted to administrative expenditures. Such events and policies make insurers use provider data management and to reduce costs and improve efficiencies.
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